Contact Dermatitis in Wood Workers

Net Letters

CContactontact ddermatitisermatitis iinn WWoodood of a pruritic eczematous eruption. Like the first patient, the lesions only appeared after 30 years of professional activity wworkersorkers and were aggravated during work period. Examination revealed [Figure 2] erythematous papular lesions and lichenified plaques localized on the exposed areas of the Sir, face, neck and forearms. Wood and wood dust can cause a wide range of cutaneous reactions, including folliculitis, contact urticaria, and both Patch tests in both patients were performed with the irritant and allergic contact dermatitis. The majority of Portuguese Contact Dermatitis Standard Tray, and fresh wood-induced contact dermatitis occurs in woodworkers[1] sawdust samples from 30 wood samples in 1 and 10% and most involved sawdust woods are “exotic” species petrolatum [Table 1]. from tropical regions.[2] Solid wood products such as musical instruments are rarely sensitizing.[3] As exposure in The patches were applied with Finn chambers to the skin on woodworkers occurs with fine dust created during wood the back, removed after 48 hours and read by 72 hours. processing, the initial clinical picture is typically that of airborne contact dermatitis. After 72 hours, the first patient revealed positive reactions to colophony and five saw dusts in 10% Case 1 petrolatum (MDF, agglomerate, pine, Scotch pine and A healthy 54 year-old Caucasian woodworker (sawyer) Tabopan) [Table 2]. The second patient demonstrated presented a history of pruritic eruption on his face after 36 years of professional activity. There were no systemic positivity to colophony, balsam of peru, fragrance mix symptoms and the patient denied any modification on the and 11 saw dusts incorporated in 1 and 10% petrolatum type of woods he crafted. (MDF, agglomerate, pine, Scotch pine, Agba, chipboard, Pau sangue, ironwood, ebony, Coeur dehors and kambala, The physical examination [Figure 1] revealed erythema, [Table 2]. small vesicles, and scaling on the face (involvement of the eyelids, postauricular and infranasal folds), jaw area, Considering that many woods have strong irritant neck and the V of the chest, hands and forearms. These properties and that the first patient only revealed positive episodes were so severe that they needed repeated results to sawdust in 10% petrolatum, patch tests with visits to emergency service and the need of systemic the same saw dusts were carried out in ten controls. All corticosteroids. these controls were negative, negating the hypothesis of irritant contact dermatitis. However, this conclusion was Case 2 limited by the small number of controls. A healthy 56 year-old Caucasian woodworker (cabinet- marker) had been referred to our department for evaluation As photo-exposed areas were involved in both patients, we carried out photopatch tests. Negativity in these tests permitted us to exclude photo-allergic contact dermatitis.

Figure 1: Case 1: Involvement of the face, and neck Figure 2: Case 2: Dermatitis in an airborne pattern

Indian J Dermatol Venereol Leprol | July-August 2008 | Vol 74 | Issue 4 441 Net Letters

Table 1: Wood dusts tested in our patients Woods dust 1. Pine (Pinus pinaster) 1, 10% 16. Walnut (Juglans nigra) 1, 10% 2. Poplar (Populus tremula) 1, 10% 17. Tulip-Tree (Spathodea campanulata) 1, 10% 3. Oak (Quercus pedunculata) 1, 10% 18. Yellow wood (Manilkara huberi 1, 10%) 4. Kambala (Chlorophora excelsa) 1, 10% 19. Scotch pine (Picea abies) 1, 10% 5. Ironwood (Macherium scleroxylum) 1, 10% 20. Agba (Gosweilerodendron balsamiferum) 1,10% 6. Ash (Fraxinus excelsior) 1, 10% 21. Chipboard 1, 10% 7. Walnut (Aleurites moluccana) 1, 10% 22. Pau sangue (Pterocarpus rohrri) 1, 10% 8. Chestnut-tree (Castanea sativa) 1, 10% 23. Mutenye (Guibourtia arnoldiana) 1, 10% 9. Cherry-tree (Amburana cearensis) 1, 10% 24. Cordia wood (Fraxinus excelsior) 1, 10% 10. Agglomerate 1, 10% 25. Coeur Dehors (Diplotropis Purpurea) 1, 10% 11. MDF 1, 10% 26. Tabopan 1, 10% 12. Beech-Tree (Fagus sylvatica) 1, 10% 27. Sapele (Entandrophragma cylindiuun) 1, 10% 13. Alder (Alnus Tenuifolia) 1, 10% 28. Coutibé (Nesogordonia papaverifera) 1, 10% 14. Eucaliptus (Eucalyptus abdita) 1, 10% 29. Yellow Pine (Pinus echinata) 1,10% 15. Mahogany (Swietena Mahogani) 1, 10% 30. Ebony (Zollernia paraensis) 1, 10%

be a wood allergy marker, we could not perform any test Table 2: Patch test positives with it because the substance was not available. Positivities Case 1 Case 2 Standard Colophony (++) Colophony (+++) Tray Balsam of peru (+) The cases described here clearly show that airborne Fragrance mixture (+) contact dermatitis occurs with the involvement of Fresh MDF 10% (+++) MDF 1, 10% (++) other woods besides “exotic” types. In the second saw dust Agglomerate 10% (+++) Agglomerate 1, 10% (+++) samples Pine 10% (++) Pine 1, 10% (++) patient, we can infer that the reaction was allergic, Scotch pine 10% (++) Scotch pine 1, 10% (++) but the negativity to saw dusts in 1% petrolatum in the Tabopan 10% (+++) Agba 1, 10% (++) Chipboard 1, 10% (+++) first patient does not allow us to exclude an irritant Pau sangue 1, 10% (++) reaction. The positive patch test reaction to wood Ironwood 1, 10% (++) sawdust demonstrates clinical relevance because the Ebony 1, 10% (++) Coeur Dehors 1, 10% (++) patients work with these woods on a daily basis and Kambala 1, 10% (++) the dermatitis resolves on its own whenever they avoid (+): Weak (nonvesicular) reaction: erythema, inÞ ltration, papules wood contact. (++): Strong (edematous or vesicular) reaction (+++): Extreme (spreading, bullous, or ulcerative) reaction It is interesting to note that the clinical manifestations appear Woods and wood handling can cause various skin and for a long time after woodworking activity, apparently with mucosal adverse symptoms. Almost any wood dust has the no modification on the type of woods crafted. This may be potential to be an irritant agent when it comes in contact justified by the multiplicity of some woods’ common names with the skin. Nevertheless, occupational allergic contact reported by our patients, which made wood identification dermatitis is rare.[4] The most recognizable allergic woods somewhat difficult. Ideally, woods should be identified by include cedar, pine, poplar, oak, rosewood, teak and ebony.[5] their genus and species names. Quinones, stibenes, phenols and terpenes are some of the compounds that have been identified as contact allergens Colophony is the natural solid residue that remains after in woods.[5] distilling the volatile oil (turpentine) of the pine oleoresin. The positivity in both patients seems to be related with pine When wood contact dermatitis is suspected on a clinical dust positivity. basis, patch testing should be performed with fresh sawdust from the same wood species crafted by the patient.[4] Wood agglomerate, MDF, and Tabopan are produced by agglutinating wood-waste fibrous elements with the gum Although 2,6 dimethoxy-1,4 benzoquinone is considered to of formaldehyde. Taking into account that neither of our

442 Indian J Dermatol Venereol Leprol | July-August | Vol 74 | Issue 4 Net Letters patients had positive reactions to formaldehyde, the AAddressddress fforor ccorrespondence:orrespondence: Inês Machado Moreira LoboEdifício das consultas Externas do Hospital Geral Santo António, Ex CICAP, Rua D. positivity to these wood agglomerates seems to be in Manuel II, S/n4100 Porto, Portugal. E-mail: [email protected] agreement with pine dust positivity. In spite of these facts, we cannot exclude the involvement of other unknown wood RREFERENCESEFERENCES constituent elements. 1. Correale CE, Marks JG. Contact dermatitis in a woodworker. Am J Contact Dermat 2002;13:42-4. Prevention of allergic contact dermatitis to wood dust in 2. Weber LF. Dermatits venenata due to native woods. Arch sensitized workers is usually difficult. Both our patients Dermatol Syphilol 1953;67:388-94. needed to leave the woodworking activity to get long- 3. Scheman AJ, Xu Y, Osborne A. Allergic contact dermatites term relief from the wood dust-associated contact to Fraximus americanus and Macherium acutifolium. Am J Contact Dermatol 1999;10:233-5. dermatitis. 4. Estlander T, Jolanki R, Alanko K, Kanerva L. Occupational allergic dermatitis caused by wood dusts. Contact Dermatitis II.. LLobo,obo, MM.. FFerreira,erreira, EE.. SSilva,ilva, SS.. MMachado,achado, 2001;44:213-7. MM.. SSeloreselores 5. Zug K, Marks J. Plants and woods. In: Adams R, editors. Department of Dermatology, Hospital Geral de Santo António, EPE, Occupational Skin Disease. Philadelphia: Saunders; 1999. p. Porto, Portugal 567-93.

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